Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175M00000X | Lay Midwife | 15070005 | FL |
Y | 176B00000X | Midwife |
NPI | 1063817476 |
---|---|
Provider Name | Bryant Patrice Cassidy |
First Address | Taylor, TX 76574-4873 |
Second Address | Taylor, TX 76574-4873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2014 |
Last Update Date | 25/01/2022 |